By Warren Holleman

I used to work with victims of child abuse and partner violence. They tended to cope by not being aware of how they felt.

That’s because they were stuck in survival mode, where one erects a wall of protection, hunkers down, and stays vigilant. This is often referred to as “fight or flight”: all energy and attention are directed toward self-preservation and safety.

A person in this situation doesn’t have the luxury of being aware of their softer, sadder feelings. This would make them weak and vulnerable to further abuse. To survive, they had to have a thick skin.

Such behavior is adaptive for managing a dangerous situation, but once you extricate yourself from that situation, you need to dismantle that wall, establish positive relationships, and get in touch with all those buried feelings.

Which is easy to say, but very hard to do. Especially if you aren’t wealthy enough to afford the assistance of a professional counselor. So, for most of the traumatized women I worked with, their journey to mental health and happy relationships took major detours.

The first detour was usually addiction. Alcohol and drugs can be very effective in helping individuals cope with negative, scary feelings. Not nearly as effective as psychotherapy, but if you can’t afford psychotherapy, it’s the next best thing.

Another common detour: relapse to other abusive relationships. Again, this doesn’t work as well as psychotherapy, but if you have low self-esteem and are feeling lonely, and the only type of relationship you know is an abusive one . . . . You get the picture.

So our counselors at the transitional living center tried to create a safe, supportive space where our clients could get in touch with all those emotions—negative and positive—they had buried for years or for a lifetime. Softer emotions like sadness, loneliness, and shame, like serenity, confidence, and joy, like kindness and gentleness and patience. And harder emotions like anger and rage, fear and frustration, regret and bitterness. As these women came to terms with their trauma and the feelings surrounding that trauma, they began to heal.

To facilitate this process, we posted charts like this one all over our counseling center’s walls. Such charts were designed, of course, to help children develop emotional awareness. But our adults found they needed it just as much as their children.

By now you’re probably wondering why I took this detour: what do child abuse and partner violence have to do with stress management? Let me explain.

Six years ago I changed jobs. I left the women’s transitional center and became director of a wellness program for physicians and scientists at an academic health cancer. I assumed that this work of helping people become emotionally self-aware was in my rear view mirror. Surely faculty physicians and scientists had a handle on this sort of thing.

Boy, was I wrong! I discovered that health professionals were every bit as much the poster children of the “Thou Shalt Not Be Aware” moniker as victims of child abuse and domestic violence. Here’s why.

Caring for seriously ill patients is itself a very traumatic experience. Doctors and nurses experience vicariously the pain and suffering of their patients and their patients’ families. They need to take time every day to process that “secondary trauma”* with their treatment team, but most don’t. Instead, they build a wall, hunker down, and stay vigilant. Sound familiar?

So, when doctors and scientists ask for my help, I try to address the systemic problems that contribute to their toxic work environments. Just as the women at the transitional living center came out of abusive family systems, our doctors and scientists find themselves in organizational systems that are abusive in many ways.

But of course I also try to help them on an individual level. And you know what I do? The same thing I did at the transitional living center! I try to help them become aware of the emotions associated with their negative stressors.

“Dr. X,” I ask, “how are you feeling today?” “Busy,” she replies. “That’s not really a feeling,” I say. In our brief hallway conversation she discovers she feels overwhelmed, under-appreciated, and worried. Worried about her patients, her marriage, and her children. When I ask her if it would be helpful to share some of these feelings with her clinical team, and others with her husband, she hesitates and says she’ll think about it.

“Dr. Y,” I ask, “how are you feeling today?” Dr. Y, a basic scientist, launches into a tirade about the bureaucratic inefficiencies of our institution. “I have a grant due Thursday, and I’ve got to waste my time doing A, B, and C! I’ve worked on this project for months and now I may miss the deadline. If I don’t get this grant, I’ll have to fire members of my lab team!” Clearly, Dr. Y is angry and frustrated, but he doesn’t really know it. He’s just a cornered animal fighting for his life. Or, more precisely, he’s in career survival mode, using the only tools he has in his toolbox: fight or flight. In our brief conversation, he is able to name his surface feelings—anger and frustration—and he begins to realize that underneath these feelings are deep-seated fears about his future, his staff’s future, and his family’s future. I encourage him to explore those feelings with those he trusts, with members of his work team, and members of his family. He looks at me like I’m an alien from outer space, but agrees to talk with me again after the Thursday deadline.

So, what have I learned from my experiences in these two work settings? While there appears to be a world of difference—economically, socially, and educationally—between the homeless women in the transitional living center and the physicians and scientists in the academic health center, our needs, challenges, and solutions are essentially the same. We all experience emotional distress and trauma as the collateral damage of living our lives, working our jobs, and playing our roles in our families and our communities. We all tend to get stuck in survival mode as a means of coping with that distress and trauma–as well as the crazy busyness of all the stuff we need to do.

And, regardless of whether our dis-stress comes from family trauma, job trauma, or elsewhere in our neighborhood or community, the solutions are the same. First, take the time to learn the names of your stressors and the emotions associated with them. This sounds simple, but how often do you find yourself being truly articulate in moments of distress? I catch myself using generic language like: “I feel bad” or “I feel awful.” A 3rd grader could say that! Instead I need to recognize exactly how I feel and describe it accurately to others. Here are some examples from last week: “I feel tired and irritable.” “I feel unappreciated.” “I feel stuck and am beginning to get frustrated.” “I feel relieved to know what’s going on.” “I feel excited about this new possibility.” Second, share that information and those insights with people you trust. Cultivate relationships at work, home, and in the community where you feel comfortable sharing your feelings and feel confident of receiving emotional support in return. Again, this is basic stuff, the preventive maintenance we must do to stay healthy and happy over the long haul of our lives and our careers. But when we get caught up in the tyranny of the urgent, all that preventive maintenance gets postponed. Take the time you need to identify your stressors, name the emotions associated with them, and share them with people you love and trust.

*If you’re a health professional suffering from the secondary trauma, I encourage you to check out the Vital Hearts resiliency training program. The program was designed to help nurses, doctors, psychotherapists, chaplains, and other health professionals develop tools for managing the stress of working day in and day out with those who are sick and suffering.